It is common for you to feel sad or depressed after a heart attack, cardiac surgery or procedure, recent hospitalization, or new diagnosis of heart disease. These emotions may be the result of not knowing what to expect or not being able to do simple tasks without becoming overly tired.

Temporary feelings of sadness are normal, and should gradually go away within a few weeks, as you get back to your normal routine and activities.

Sometimes, however, a depressed mood can prevent you from leading a normal life. When a depressed mood is severe and accompanied by other symptoms that persist every day for 2 or more weeks, treatment is necessary to help you cope and recover.

How do I know when to seek help?

If you’re recovering from heart surgery, a heart attack, or another heart condition, temporary feelings of sadness and a depressed mood are common for the first few weeks.

However, treatment is necessary when depression is severe and accompanied by other symptoms (including withdrawal from activities, not responding when visiting with family and friends, increased negative thoughts and tearfulness).

Without treatment, depression can become worse. For heart patients, depression can contribute to an increased risk of heart attack and coronary disease. Talk to your health care provide who can diagnose and start depression treatment with safe antidepressants. Your health care provider also can refer you to a mental health specialist who can provide other appropriate treatment when necessary.

When depression is negatively affecting your life — such as causing increased difficulties with relationships or performance at work or at home, it is important for you to get help to prevent things from getting worse.

• Get dressed every day.
• Practice stress management and relaxation techniques.
• Get out and walk daily.
• Follow your prescribed exercise regimen.
• Ask your health care provider about a cardiac rehabilitation program.
• Resume hobbies and social activities you enjoy.
• Share your feelings with your spouse, friend or a member of the clergy.
• During your recovery from surgery or a recent hospitalization, visits with friends should be limited to 15 minutes at first. Then, increase the amount of time spent with visitors, depending on how you feel.
• Get a good night’s sleep.
• Eat well-balanced, nutritious meals and follow your prescribed dietary guidelines.
• Ask your health care provider about support groups that may help you cope. Support groups are available for patients who have had heart surgery and their families.
• Don’t use harmful habits to cope, such as smoking, using drugs, drinking excessively or overeating. These harmful habits increase your risk for heart disease and stroke.

The support and involvement of family and friends can be crucial in helping someone who is depressed. Living with a depressed person can be very difficult and stressful on family members and friends.

Do not hesitate to call for help - either for your loved one or yourself.

(reprinted with permission of Cleveland Clinic)

Advanced Counseling is pleased to offer group therapy specially designed for mothers who have children deployed in Iraq or Afghanistan.

Suzanne Rodgers, LMSW (a therapist in our Southfield office), is accepting new group members with a focus on providing a safe and supportive environment for Moms to talk about their experiences around the issue of deployment.  Discussions include before, during and after the deployments and how it affects the relationship between husbands and wives;  how it affects Moms and children;  how it affects the children;  and how it affects children and Dads. 

For information about these groups, please call: 248-213-0501 Extension: 3109 (or you can reach Suzanne on her cell phone: 313-477-7238).

The Southfield office is located on Telegraph, just north of 12 Mile, in the Comerica building.

Advanced Counseling is accredited through CARF (Commission on Accreditation of Rehabilitation Facilities).  As part of our ongoing effort to insure that we are providing the best care possible, we randomly ask our clients to fill out Satisfaction Surveys. These surveys are to measure the satisfaction with various areas of service(s) provided.  Below, please find the results of those surveys and actual quotes from current clients.

96% of patients surveyed report that when calling to schedule an appointment, they are able to obtain an appointment within a reasonable time.

97% of patients surveyed find the clerical staff to be professional and courteous.

97% of patients surveyed report that they are able to obtain an appointment at a time that is convenient for them.

94% report that they feel their therapist understands and cares about their needs.

92% of patients report that the services they are receiving at Advanced Counseling are making a positive difference in their lives.

94% of patients report being satisfied with the services they are receiving.

have gotten the most from here."

"You guys have helped so much. I feel like you are extremely confidential too. Thanks so much."

"My therapist is a life saver."

"My therapist has made such a positive difference in my life and the life of my family I just wanted to recognize her for this. She is an awesome therapist."

"Wonderful service. J"

"I drive quite a ways and have continued coming because of the services I am receiving.  Thanks."

"I am very satisfied and thank god you were here."

"I want to thank your staff for there kindness and professionalism….my therapist’s guidance has helped changed my life. Thank you thank you thank you."

"Please give thanks to all of your office workers for their professionalism and good nature.  I would also like to take my hat off to my therapist for a job well done."

We thank all the clients that voluntarily participated in these surveys and will continue to strive to maintain the level of care they have become accustomed to at Advanced Counseling.

Michigan residents are facing economic, employment and housing crises that surpass levels in recent history.  Dealing with the effects of this stress can be difficult and, at times, feel impossible to overcome.

One method of stress management is called the TARP method, and it has been proven effective for many. A tarp is a protective cover thrown over something - a car or boat, for example - to protect it from the elements. Likewise, the TARP method offers a form of protection, too - protection against the distressing and sometimes harmful effects of stress.

The TARP method teaches simple techniques that can be used any time, anywhere, to control your response to stressful situations. It consists of four steps:

• T is for "Tune in" - Get into the habit of noticing early signs of stress.
• A is for "Analyze" - Think about the source or causes of your stress.
• R is for "Respond" - Deal with the cause of your stress, and its effects on you.
• P is for "Prevent" - Develop good stress-reduction habits for a healthier lifestyle.

In addition to the TARP method, other activities and methods also can help manage stress.

"Tune in"

Tuning in is important, because if you don't tackle your stress early, it can interfere with your sense of well being and your health almost before you know it. And the effects of stress often get worse as time goes on.

Whenever you notice yourself feeling the beginnings of stress - for example, when you feel irritable, tense, distracted, or fatigued - scan yourself for signs of stress.

Learning to spot signs of stress instantly can take practice. But if you make a point of scanning your body, behavior, feelings, and thoughts regularly, it will get easier.

"Analyze"

Once you know how to "tune in" to your signs of stress, you will be better able to analyze the situations that are stressful to you. These "stressors," as they are called, could be either external or internal.

External stressors are things and events outside your body that can make you feel threatened or out of control. For example:

• Physical irritants like noise, pollution, heat, or humidity
• Work demands or conditions
• Frightening events, like narrowly escaping a traffic accident
• Social or family demands, changes, or problems

Internal stressors result from one's own attitudes and thinking patterns. For example:

• Do you always talk to yourself with words like "should, must, and ought?"
• Do you feel like a failure if you are late, or if things don't go as planned?
• Do you have "me last" syndrome, feeling you have to look after everyone else's needs before you think of your own?
• Do you feel worthless unless everyone likes you all the time?
• Are you guilty of "awful-izing," which means always expecting the worst? For example, if family members are late, do you often imagine they are injured or dead?

How-To Information:

A stress diary can be helpful in the analyzing stage. For one week, write down all the stressors you can identify. Don't leave anything out. Here's an example:

When you have about a week's worth of diary entries, study them. See which of them are caused by external events (for example, other people making you late) and which are mostly caused by your own way of thinking or feeling (for example, you are worried about something that may never happen).

In some cases, you may find that stress is caused by a combination of internal and external factors. For example, you might be worried about the cost of fixing the car, and make it worse by blaming yourself for not earning more money.

Sometimes, just by keeping a stress diary you will be able to see solutions to problems that have been bothering you. For example:

• If the commute is a major source of stress, try a different way of getting to work.
• If you are worried about your future at work, discuss this with your supervisor; you may find your worries are groundless.
• If you are always rushed, you may be able to work out better ways to manage your time.
• If your children are upsetting you at a certain time of day, have a family conference and agree on a different way of doing things.

Unfortunately, we often cannot simply remove the cause of our stress. But we can change the way we deal with it, both in the short term (as "first-aid") and in the long term (developing a stress-resistant lifestyle).

"Respond"

"Responding" in the days of early man meant fighting the source of stress or running away from it. Your body will still produce a physical "alarm response" that pumps stress hormones through your body, tensing your muscles and speeding up your heart. This "alarm response" in most cases doesn't do us any good - and it can be harmful.

You can learn to turn off the alarm response and regain control. You can learn to respond calmly, and deal actively and positively with your stress, whether it is caused by outside or internal factors.

Four useful techniques for responding calmly are:

1. Time out. A brief time out is the simplest possible approach to stress:

• Stop the activity (or the conversation) that was causing you stress.
• If you can move away, go to another room, or go for a short walk.
• If you can't move away, count to 10 silently before you speak again.
  

2. Breathing. You can often tell if people are under stress because of the way they are breathing. For example, customs officers have noticed that smugglers are the people taking fast, shallow breaths. If you learn to control your breathing, it will help you regain control over the effects of stress.

• Watch babies breathing; their abdomens expand when they breathe in.
• Watch a tense adult breathing; there may be no movement of the abdomen. All the work is being done by the chest.

Abdominal breathing can be very soothing, because it slows you down. It is also efficient, bringing a good supply of oxygen to your brain. Prepare for stressful times by practicing your breathing now:

• Check your breathing pattern by putting one hand on your chest and one hand on your stomach. If your lower hand moves and your top hand does not, you are doing abdominal breathing. But if your top hand moves and your bottom one does not, you are doing chest breathing.
• To do abdominal breathing, get your stomach relax. Breathe in deeply, then breathe all the air out. Let your lungs fill with air again naturally, while your stomach expands.
• Practice this "belly breathing" whenever you have spare time (for example, while you are driving).
• Whenever you are stressed, worried, or tense, use your breathing to help calm yourself down. Take a deep breath and quietly let it go out completely, then let your abdomen expand as the air comes back into your lungs. Keep noticing your abdominal breathing for another few breaths.

For a variation on this breathing technique, try "10-to-one countdown" breathing:

• Start with abdominal breathing, letting all the breath out and then allowing your abdomen to expand as your lungs fill up again.
• When you breathe out again, say "10," letting go of tension as if it is being carried out of your body with the air.
• Next time you breathe out, say "nine," and so on, all the way down to "one."
• When you get to "one," start again.
• Each time you breathe out, tell yourself you are letting go of tension.
• Many people repeat this sequence slowly for a period of 15 to 20 minutes. They find that with each new countdown, they reach a deeper level of relaxation.

When we are under stress, we often feel things are happening too fast. Another technique, called slow-down breathing, can help you get settled down and in control. It starts with abdominal breathing, and uses cue words to help you focus and clear your mind. Examples of cue words are:

• As you breathe in, silently say "calm"
• As you breathe out, silently say "smiling"
• As you breathe in, say "present"
• As you breathe out, say "now"

Practice breathing techniques for five or 10 minutes until you get the feel of it, then again several times a day for a few moments. Then it will be instantly ready to use as a "mini-tranquilizer" whenever you notice yourself starting to feel tense or out of control.

3. Progressive muscle relaxation. This technique will help you get rid of the muscle tension that is a major sign of uncontrolled stress, and which can lead to headaches, back pain, and muscle pulls. It is based on the principle that muscles go to a deeper level of relaxation after they have been tensed.

• Lie on the floor or on a firm bed, or sit in a chair that has good head support.
• Close your eyes and breathe deeply two or three times.
• Next, tighten up the muscles of different parts of your body in turn; keep them tight while you count silently to five; then let go and imagine the tension going out as you relax and smooth the muscles.
• Start with your face. Squint your eyes, tighten your teeth and jaw, and wrinkle your forehead. Feel the tension while you count silently to five, and then let go of it. Feel the warmth of relaxation coming to your face.
• Next, pull your shoulders up until they nearly touch your ears. Feel the tension while you count silently to five. Then let go.
• Now progress through the rest of your body, tightening muscles while you count slowly to five, then letting the tension go. Start with your stomach and chest muscles, then your lower abdomen, buttocks, and thighs. Finish with your lower legs, curling up your toes and tightening calf muscles to feel the tension in your foot, ankle, calves, and knee.
• When you have finished, notice the tension and release in all your muscles. Breathe deeply a few times, and feel relaxed, refreshed, and comfortable.

4. Thought-stopping. This is a good technique for dealing with stress that comes from your own negative feelings. When you notice negative thoughts, just say "stop!" to yourself. It may sound too simple to be effective - but it works, even though you may have to repeat the word several times until the negative thoughts are interrupted.

Sometimes, using mental images can help you stop the negative thoughts:

• Imagine that the negative thoughts are coming from a tape recorder, and that you can push the "stop" button or turn down the volume to zero.
• Imagine sticky paper that catches your negative thoughts as they fly about.
• Imagine a "stop" sign that blocks your negative thoughts.
• Imagine a box that your negative thoughts get trapped in.
• Imagine you are driving through a car wash that washes the thoughts away.

"Prevent"

There are simple things you can do to help your body and mind withstand stress. These will help you improve your immune system, your energy level, your self-esteem, and your sense of well-being.

1. Relaxation. Relaxing regularly will help prevent stress.

• Set aside just 15 minutes every day, whether you are feeling stressed or not.
• Go through whatever relaxation procedures work best for you. Techniques such as yoga and stretching can be effective, as can progressive relaxation techniques.

2. Regular exercise. If you know people who run, swim, or bicycle regularly, you may notice that they have less stress than others. When your body is in first-class condition, your mind and emotions will also benefit. Regular exercise is one excellent way to "stress-proof" yourself, or at reduce the bad effects of stress.

Exercise can make you look better, sleep better, concentrate better, and withstand disease better. It will also improve your mood and make you feel better about yourself. The best exercise for stress-proofing is aerobic activity, which uses your whole body. This includes jogging, bicycling, brisk walking, cross-country skiing, aerobic dancing, swimming, rowing, skating, and stair-stepping.

• If you are not used to exercise, start with walking. Walk briskly for about 20 minutes, three times a week.
• As you get in shape, take longer walks, or switch to a more vigorous form of activity.
• If you don't have access to a lake, mountain, or country road to row, ski, or bike on, substitute on machines at home or in a gym. But whenever you can, get out into nature. The quietness and change of scene will help your stress levels.

3. Eating right. You will be much better able to withstand stress if your body feels good, and it can't feel good if you don't feed it properly.

• Make sure you have three good meals a day, with plenty of fruit, vegetables, and filling food like bread, rice, or noodles.
• If you get hungry between meals, plan for a nutritious snack like fruit, yogurt, or a bagel. If you take a snack to work with you, you won't be tempted by junk food.

Eating well will give you a sense of control that can help to reduce your stress levels, as well as making you feel good physically.

4. Chemicals: alcohol and drugs. People may be tempted to take a drink or drugs to deal with stress. It doesn't help. Alcohol may seem to calm you down, but it only masks the symptoms of stress for a while. Excessive alcohol (and drugs) will give you a rebound; you are likely to feel more stressed than ever when the effects wear off.

One or two drinks a day, such as a glass of wine or beer with dinner, usually won't harm you. If you are regularly drinking much more than that, cut down - and if that is hard to do, get some help.

5. Tobacco. People often say that a cigarette "calms their nerves," but tobacco is really a stimulant. If you are afraid that quitting would cause you too much stress, talk to your doctor about prescribing a nicotine patch or gum to help ease the difficulty of withdrawal. Patches or gum work best if you also join a quit-smoking group or use a good self-help program that helps you learn to be a nonsmoker. In the long run, you will become a calmer person if you stop smoking.

6. Caffeine. People have different reactions to caffeine, and most people can take two or three cups of coffee or tea a day without trouble. But you might try cutting down your caffeine intake, to see if you are less jumpy. (If you get a headache for a few days, don't worry; that's a normal withdrawal symptom, and it will go away within a week.)

When all else fails, don't hesitate to call a professional to talk to about managing your stress and the impact on health, relationships and families.

(article reprinted with permission from ehealthMD.com)

The recent events surrounding Chris Brown and Rihanna raise the question again about physical abuse between two people and domestic violence.  Many surveys show a disturbing split in people between the ages of 19-25, in terms of who they blame:  seems it almost runs 50/50.

Below is some infomation from the National Center for Domestic Violence.  Read it, think about your own situation and call for help if see yourself in any of the following situations:

What is Domestic Violence?

It seems only right on Veteran's Day to honor our servicemen and women. To all of our military personnel, both active, inactive, retired and their families, Advanced Counseling is proud to be able to offer help.  For soldiers returning from war and their families, we can help with the many issues you may face.

Combat fatigue syndrome, post-traumatic stress, traumatic brain injuries and the multitude of adjustments both the soldier and his/her family face when returning from combat can seriously impact lives.

Contact any one of our 6 locations or visit other areas of our website for additional information, resources and phone numbers to make an appointment. 

Be sure to visit MilitaryAvenue.com to see our ad and our coupon for first-time visits.  Click on Army and then find your installation (i.e. Selfridge ANG Base).  Then click on Health in the left hand column, to find us listed under Counseling.

Whether it is PTSD, anxiety, adjustment issues, substance abuse, domestic violence or anything else interrupting your life, we are here to help and offer assistance to our troops and their families.

Thank you for visiting our website and thank you for your service to our country!

Mental health

An estimated 60 million Americans age 18 and older -- about 25% of the adult population -- suffer from a diagnosable mental disorder in any given year, says the National Institute of Mental Health. Even famous author J.K. Rowling, creator of the Harry Potter series, suffered from depression and contemplated suicide. According to the World Health Organization, mental illnesses, including depression, bipolar disorder and schizophrenia, are among the 10 leading causes of disability in the United States and other developed countries, points out Dr. Sergio Aguilar-Gaxiola, chairman of the board of directors of Mental Health America (mentalhealthamerica.net). We asked Aguilar-Gaxiola to give us the myth-busting facts on mental illness.

Myth: Mental illnesses are only in your mind; they're not real illnesses.
Reality: Mental illnesses are serious medical conditions, just like cancer or diabetes, that can have a dramatic impact on a person's life, family and community and on society as a whole -- and they can be tremendously debilitating. Since 1996, we have more data on the impact of mental illnesses on functioning than we ever had before, thanks to "The Global Burden of Disease," a landmark study done by the Harvard School of Public Health. That study showed that, when compared with any other health condition, mental illnesses are among the most debilitating, and depression is the No. 1 cause of disability internationally.

Myth: Only crazy people are mentally ill.
Reality: There is nothing crazy or abnormal about people who have a mental illness. It's a very democratic condition; we are all at risk. We all likely have at least one relative, loved one, neighbor or co-worker who is living with a mental illness. Mental illnesses are just that -- illnesses.

Myth: Treatment goes on forever and doesn't really help.
Reality: We know mental illnesses are, for the most part, highly treatable, and most people do get better when they're treated appropriately. For example, about 80% of people who seek treatment for depression -- one of the most treatable of all mental illnesses -- will improve with therapy or medication or a combination of the two. A diagnosis of depression does not mean you face a lifetime of analysis or medication. The myth that mentally ill people cannot get better perpetuates the barrier of stigma, embarrassment and fear that deters some people from recognizing and accepting that they have a mental illness -- and then seeking and receiving help.

Myth: Mental health isn't as important to your well-being as physical health is.
Reality: Mental health is an integral part of health. When our mental health is poor because of stress or other challenges in our lives, it can weaken the immune system and affect the entire body. We know that chronic stress can play a role in obesity, diabetes, hypertension and heart disease. People who feel depressed are overly stressed and may be at greater risk of physical illness.

Myth: Antidepressants cause children and teens to commit suicide.
Reality: The U.S. Food and Drug Administration has issued warnings regarding the use of antidepressants in children because of the relative lack of research on the safety of those medications for youths. More recent studies indicate that the benefits of treatment with antidepressants appear to be greater than the small risk that patients' suicidal thoughts and behaviors would be increased by taking that medicine.

Myth: Changing behavior is easy. All it takes is willpower to overcome mental illness.
Reality: If changing behavior were easy, everyone would find it easy to lose weight and follow healthful habits. Those of us in the mental health field always are looking for ways to help people make behavioral changes so they can live healthy and fulfilling lives. For example, one of the most useful ways to effectively deal with depression is behavioral -- exercise, eat a balanced diet, relate to other people and do not get isolated, even when you feel like saying, "What's the use?"

Bottom Line: We cannot separate mental health from health in general. The fact is, good health begins with mental health.

(USA Weekend; June 16-19, 2008)